The State of Maryland has a well-established Lead Poisoning Prevention Program. The[unreadable] Childhood Lead Poisoning Prevention Program (CLPPP) was established in the Office of[unreadable] Environmental Programs (OEP) within Maryland Department of Health and Mental Hygiene[unreadable] (DHMH) in 1985, and the Maryland General Assembly passed the statute and regulations to[unreadable] require laboratories to report the result of blood lead tests on Maryland children to the State in[unreadable] 1986. The OEP evolved into the Maryland Department of the Environment (MDE) in 1987. The[unreadable] first CDC grant to the Maryland CLPPP was awarded in 1991 to the Lead Poisoning Prevention[unreadable] Program in MDE.[unreadable] Since the adoption of the Reduction of Lead Risk in Housing law in the 1994, strategic[unreadable] partners such as rental property owners and managers, housing agencies, health agencies, and the[unreadable] Coalition to End Childhood Lead Poisoning (CECLP) have continuously worked in close[unreadable] partnership with MDE through the Lead Poisoning Prevention (LPP) Commission. The LPP[unreadable] Commissioners maintain close ties with many other strategic partners. The Governor appointed[unreadable] MDE as the lead in the Tri-State agencies that include the Department of Health and Mental[unreadable] Hygiene (DHMH) and the Department of Housing and Community Development (DHCD) as[unreadable] major public funding partners.[unreadable] DHMH has been funded by the State since 1997 to conduct the Lead Screening Program.[unreadable] Public Health officials in many offices at DHMH actively initiate and participate in lead partner[unreadable] meetings about a variety of issues such as the testing of African refugees, investigations of[unreadable] methods to increase testing rates, and investigations of resources for relocation of poisoned[unreadable] children. Medicaid, part of DHMH, performs the annual match of blood lead data from the[unreadable] Childhood Lead Registry (CLR) with Medicaid data. Medicaid uses the matched data to[unreadable] increase the testing rate of Medicaid children and to assure that those children with EBLs (blood[unreadable] lead level &#8805; 10 ?g/dL, CDC level of concern) are being properly case managed.[unreadable] Since the inception of the program, there has been steady decline in childhood lead[unreadable] poisoning in Maryland. The decline has occurred both statewide and in areas of high risk such as[unreadable] Baltimore City, the most urban area of the state, and the Lower Eastern Shore, the largest rural[unreadable] area. In spite of these achievements, childhood lead exposure (poisoning) in Maryland is still of[unreadable] major concern. The percent of EBLs among children 0-72 months for calendar year 2004 was[unreadable] 1.7% statewide, which is still higher than the NHANES report of 1.6%. The correspondent[unreadable] figures for 0-35 months and 36-72 months are 1.6% and 1.8% respectively. Living in pre-1950[unreadable] housing units, living in poverty and being from minority groups, are the major risk factors for[unreadable] childhood lead poisoning in the State of Maryland.[unreadable] The blood lead screening rate of children 0-72 months for 2002-2004 averaged 19.8%[unreadable] statewide, with a range from 34.2% in Baltimore City and 27.6% in the Lower Eastern Shore[unreadable] counties (defined as at-risk areas by Targeted Screening Planning) to 17.4% in the ?not at-risk?[unreadable] areas. No matter what the risk status of the area, because of higher risk of lead exposure among[unreadable] children one and two years old, blood lead testing was more concentrated among these children.[unreadable] According to the surveillance data maintained in the electronic CLR since 1992, the percent of[unreadable] EBL declined persistently over the years in all jurisdictions, and all age groups. The high-risk[unreadable] 4[unreadable] areas (Baltimore City and Lower Eastern Shore counties) have a consistently higher percent of[unreadable] EBL compared to other counties.[unreadable] Through the passage and implementation of many primary prevention regulations, the[unreadable] State of Maryland has been successful in reducing childhood lead exposure (poisoning) statewide[unreadable] and in high-risk areas such as Baltimore City. The State?s Reduction of Lead Risk in Housing[unreadable] law?s regulations were enacted in 1996, and enforcement in MDE is active and effective. To[unreadable] achieve the 2010 goal of zero percent EBL among children 0-6 years old, the State is working[unreadable] toward a comprehensive plan of action in the Plan to Eliminate Childhood Lead Poisoning by[unreadable] 2010[unreadable] Primary prevention occurs not only according to the work practice laws, which assure[unreadable] primary prevention during abatement work, but also during tenant turn-over and in response to[unreadable] Notice of Defect or a Notice of Elevated Blood Lead Level in pre-1950 rental units. All owners[unreadable] must register their units with the Lead Rental Property Registry, provide educational material[unreadable] that includes Tenants Rights and Notice of Defect to each new tenant and every 2 years[unreadable] thereafter, and provide to their new tenants a copy of the Lead Inspection Certificate that was[unreadable] submitted to MDE that certified that a unit met a standard of care upon turnover. They also must[unreadable] certify that a unit meets a standard of care within 30 days of receiving a Notice. The law was[unreadable] amended in 2004 to prevent property owners of pre-1950 rental property from using the rent[unreadable] court system until the owner complies with the lead law.[unreadable] Secondary prevention also occurs through State and Baltimore City laws and regulations.[unreadable] In combination, the laws require health care providers to provide blood lead testing of 1 and 2[unreadable] year old children in Baltimore City and the other high risk areas designated by the Targeted[unreadable] Screening Plan, and child day care centers and schools must request proof of such testing upon a[unreadable] child?s registration in day care, preschool, kindergarten or first grade. Also, an EBL reported to[unreadable] the CLR triggers an environmental response in pre-1950 rental housing Statewide and in owneroccupied[unreadable] housing in Baltimore City. In response to an EBL, laws and regulations require that an[unreadable] Official Notice of Elevated Blood Lead level be provided to parents and property owners. In[unreadable] Baltimore City, nursing case management and an environmental investigation are triggered.[unreadable] The next 5 years will be active with improvements in systems and additional activities in[unreadable] all the components of the State?s Lead Poisoning Prevention Program. The highlights are:[unreadable] Improvement in surveillance data and reports, Electronic documentation of environmental and medical elements of case management in a single system, Enforcement of the primary prevention laws among the harder-to-reach property owners until all pre-1950 units are in 100% compliance with the law, Establishment of effective outreach and education methods to reach the general public most likely through the public school system, and Assurance that permanent evaluation components will continue to be conducted through the Governor?s Lead Poisoning Prevention Commission.[unreadable]